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Best time to inject Lantus...

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#1
Bountyman

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Well, you know me, the consummate "tester". 9 months ago I started out on Lantus. The instructions that came on the Lantus said to inject X amount of units at bedtime. Now, I think we've discussed this before and came to the conclusion that those instructions, as to 'time of day', were created so that one has a good reference point-in-time for their injection.

Some people have remarked that their Lantus doesn't last for 24 hours. I have no idea how someone comes to that conclusion. Awhile back, if some remember, I wondered how long I'd last without insulin. I stopped taking Lantus and maintained my same diet and testing times. It was 6 days before I saw a rise in my FBG. I guess my Lantus injections last me 144 hours if we're to use that as a benchmark. Anyway...

In the question of 'how long does my basal insulin last' I pondered about what time I took my Lantus. Usually it's right after dinner as that's when I shut this postin' machine down and migrate to the TV. That's around 7 o'clock. Which means that the tail end of my Lantus has to deal with my dinner...the biggest meal of my day.

So, what if there was a better time, for me, to re-up my Lantus. I understand that a basal insulin isn't designed to cover meals, that's what rapid-acting insulin is for. But I'm not a Type I, my pancreas seems to still be puttin' out like a cheap crack-whore...so I'm controlling that little spike with carbohydrate restrictions. Then again, I feel that I oughta' have the lion's share of Lantus available when I've got food inside me...not while I'm sleeping, doing nothing. So I've started a time-of-day test to see if there IS a time-of-day that my Lantus injection works best for me.

Last night I gave myself a less-than shot of Lantus, enough to last me until 9 o'clock this morning, which is where I'm starting out. It's funny, that shot was 14 units instead of 25 units and my FBG was 99 mg/dL this morning, 20 points lower than it's been in 3 weeks (go figure). My benchmarks on this test are going to be my FBG and my 1-hour after lunch.

I'll keep you all posted...if you're interested. :cool:

#2
MCS

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I am a tester of things as well. My best luck with Lantus came from injecting the main portion in the morning and reserving some of the remainder for at night. When I needed to reduce the amount I would reduce the morning dose first then the evening dose.

One thing about basal insulin I found out, if you inject more than you need, your own pancreas has a chance to store what its making for bolus. Problem is the hunger that goes along with more insulin than is needed.
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#3
Bountyman

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One thing about basal insulin I found out, if you inject more than you need, your own pancreas has a chance to store what its making for bolus. Problem is the hunger that goes along with more insulin than is needed.


I noticed the same thing. I started out at 15 units straight out of the hospital. My PA titrated me up to 20, then 22, then 25 where we found my sweet spot. On my own, a few months back I started titrating myself up to see if it would bring my FBG numbers down a little. Went to 27, then to 30. Did nothing but make me raid the refrigerator like I'd just smoked some of Humbolt county's cash crop. So, I think I'm good at 25 units. Question now being...when.

#4
plattb1

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I'll be very interested in your results. I've taken my Lantus at 10pm since I started on it 15 months ago. My "control" seems to begin to fade about 3-4 pm with evenings being my most difficult time.

To combat that, what I have mainly been doing is eating very low carb dinners, which isn't a problem for me since I'm eating moderately low carb overall. I'm just avoiding the "spikier" carbs at dinner.

Anyway, I've decided that I'm going to move my injections to mornings this weekend & see how it works. If the results are good, I'll stay with that. If not, I may do as Marty & others have suggested & try the split dose routine.
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#5
dbaratta

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I split my lantus into 2 doses, one morning one before bed, try to do no more than 12-hours apart. It seems to work so much better for me that way than the once at night. I asked my doc first of course and he gave me the go ahead. It acutally took me from 24 units a day to 12 units a day, 6 in the morning and 6 at night.

Lately though I have been struggling cause doc took me off my met. I am going back on cause it helps.:T
A1C JULY 2010 5.9%
A1C March 2010 6.2%
Lantus 16 units split dose
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#6
Bountyman

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Interesting results. Like I mentioned, my FBG was 20 points lower this morning after taking half my usual basal dose last night. Here are yesterday and today's numbers. The yesterday numbers reflect my usual numbers for the last 2 months and the test after lunch today is from an exact same meal containing 39 carbohydrates. To be succinct, a hot dog on white bun, mustard, relish and 2 tablespoons of Raley's Deviled Egg Potato Salad.

Wednesday:

FBG 120 mg/dL
1hr after lunch 176.5 mg/dL
2hrs after lunch 134 mg/dL

Thursday:

FBG 99 mg/dL
1hr after lunch 150.7 mg/dL
2hrs after lunch 116.5 mg/dL

For the first day that's a 17.5% drop in FBG; a 15% drop in 1hr after lunch and a 13% drop at 2 hours. I didn't expect these results so fast. The reason for the partial decimal values is because the after-lunch tests are an average taken from 4 tests. I know, strips are expensive, but I'm aiming at a little better accuracy in averaging.

#7
NewdestinyX

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This is a very timely thread, Bountyman. Thanks for starting it as I too just today started some experimenting with my timing of the dose and for me -- started a split. So several of us will be experimenting over these next few weeks. Let's keep posting our findings.. and if we can notice any common trends.

I've always been an 8:30am doser for fear of nighttime lows. but for me I have trouble, at this dose (for weight loss purposes) keeping the waking FBG down as far as I'd like it and I get a nasty liver dump around 4pm and almost never have an acceptable preDinner number. SO I'm trying 13iu of my 16 total in the am and 3iu before bedtime. Not gonna split it evenly just yet. Want to see if I just need a little booster for those am numbers. And then if that works I'll just do my exercise at that 4-5pm mark to combat the liver dump.

Since all of us who are experimenting so far in the thread are on Lantus I'd be interested if anyone thinks that even split doses would be in some way more effective than a larger and a smaller dose.....

Great thread, Bountyman...
Grant

Dx 7/15/09 - A1c 10.6 :o; 10/26/09-7.2 :); 1/20/10-5.7 :D; 4/10/10-5.6 [Bayer Home Test] :D
Meds: Metformin XR 500mg-2/day, Lantus 16iu morning, Diovan 80mg-1/day,
Nexium 40mg-2/day, D3 2000iu, B12 2500mcg; Diet: for now, low carb:<70g/day
Weight mngm't: Down 30 lbs since Dx :thumbsup: Exercise reg: Biking in combo w/ 45 min at gym 3-4x/week

#8
jenb

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Don't know if this helps for T2s, as you have endogenous insulin, but I've found that at my relatively small Levemir dose, a tri-split works best. To combat DP I do 11u at 10:15 p.m., then follow up at 6:15 with 7u, then 2.5u at 2:15 p.m.. I think that as one who boluses during the day, my fast acting insulin probably exerts the most control in the afternoon and early evening, hence the low basal need. Even with a bi-split, I think you'll be able to better match your basal needs at different times of the day.

Jen

#9
fgummett

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You are right Jen... and not it any way to suggest that Type 1 is "easier" but I do feel that as a Type 2 -- having at least some of my own insulin -- does "muddy the water" and I am loathe to draw conclusions about what exactly is happening in my body, other than the observable effect of any injected insulin on my BG levels.

I do know, from using an insulin pump over several years, that my basal needs are far from flat; through any given 24 hour period. Currently my "worst" BG time is around waking so I am content with a single dose of Levemir at bedtime which seems to attenuate my Dawn BG rise.

#10
NewdestinyX

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Don't know if this helps for T2s, as you have endogenous insulin, but I've found that at my relatively small Levemir dose, a tri-split works best. To combat DP I do 11u at 10:15 p.m., then follow up at 6:15 with 7u, then 2.5u at 2:15 p.m.. I think that as one who boluses during the day, my fast acting insulin probably exerts the most control in the afternoon and early evening, hence the low basal need. Even with a bi-split, I think you'll be able to better match your basal needs at different times of the day.

Jen

Ah... so it's even possible to split into '3'? I wonder how many T2's try that. Today's been a weird day.. Even with injecting 3iu of my 16 at 9:30PM and the other 13iu at 9:30am my middle of afternoon is really hard not to go low now. I've had '3 lunches' today just trying to stay above 80. I wasn't expecting that.. I had pepperoni slices, cheese and a handful of raisins as lunch...
PreLunch 79
1hrPP 92
2hrPP 82
--That's pretty flat... and I don't feel so hot that low -- for me..

Then at 3 hour I was 71.. so I had to eat something again.. 3hrPP was 4Pm today and that's my time of day when I'm normally having a liver dump... So the splitting of the dose IS having an effect.. but FBG was only 94 - which IS down from 105-106 of late.. But I want to do my exercising in the afternoon and I'd have to eat a LOT of carbs to get ready for exercise if THIS is going to be the pattern... hmmmm..

This is my Friday where I have some pancakes with my eggs and bacon and 4oz of OJ for which I bolused 2iu (during bfast at 10:30am) -- first bolus I've taken in 8-10 days.. Maybe some of the bolus was still in my system all afternoon here...

That's probably it...
Grant

Dx 7/15/09 - A1c 10.6 :o; 10/26/09-7.2 :); 1/20/10-5.7 :D; 4/10/10-5.6 [Bayer Home Test] :D
Meds: Metformin XR 500mg-2/day, Lantus 16iu morning, Diovan 80mg-1/day,
Nexium 40mg-2/day, D3 2000iu, B12 2500mcg; Diet: for now, low carb:<70g/day
Weight mngm't: Down 30 lbs since Dx :thumbsup: Exercise reg: Biking in combo w/ 45 min at gym 3-4x/week

#11
Delphinus

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You are right Jen... and not it any way to suggest that Type 1 is "easier" but I do feel that as a Type 2 -- having at least some of my own insulin -- does "muddy the water" and I am loathe to draw conclusions about what exactly is happening in my body, other than the observable effect of any injected insulin on my BG levels.

I do know, from using an insulin pump over several years, that my basal needs are far from flat; through any given 24 hour period. Currently my "worst" BG time is around waking so I am content with a single dose of Levemir at bedtime which seems to attenuate my Dawn BG rise.


Frank, I would have to agree with your sentiment.

With most Type 2's, insulin production is an unpredictable variable and something to worry about. Using insulin would actually be harder, and a bit more tricky to nail down since I am sure it would be forever changing. Insulin requirements I mean, and even by the day.

In my opinion anyway.

Anyway, like anything, nobody can say what is the best time to inject anything really, all we can do is offer up what we have tried, what has worked, what has not.

So far, I have had good success with Lantus as opposed to NPH. I am still split dosing tho, but like alot of people, the bulk of it first thing, and the rest in the evening, and sometimes 4 or 5 units more to cover DP. Sometimes even a unit or two of regular or rapid insulin to head off DP.
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#12
jenb

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Ah... so it's even possible to split into '3'? .


Definitely possible, but certainly "off-label" (LOL). I find that the worst problem with this regimen is remembering the 2:15 p.m. injection. The day gets busy, I get distracted, and before you know it, it's 6 in the evening and that basal shot has gone missing.

Jen

#13
Delphinus

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And to add.

It's possible to divide your shots up into as many as you like I guess.

As long as they are evenly spaced...

If you want to inject 1u at a time, and do it in 40 sep injections, hey, fill your boots. :D
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#14
Bountyman

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Is that coffee I smell? Bought a new coffee maker yesterday. It was either that...or clean the old one. Does the coffee taste any different? No! But the new machine has a timer on it and I've saved myself that "limbo" period where you get up in the morning, flip the ON switch, go sit down...and wait for it to go through its gurgling throws of birth.

There was a time when I'd get up, go stand in front of the coffee maker for a minute trying to decide on rather to microwave yesterday's coffee, or make a new pot. The times I opted to microwave yesterday's coffee were regrettable, very regrettable, there is an absolute difference between yesterday's coffee and fresh coffee. I finally took to preparing the coffee maker the night before. I'm happy with my new addition. I think if I'd have found a coffee maker that turned itself on and a good bamboo back scratcher when I was younger...I'd have never gotten married.

FBG this morning was 105. That's amazing considering it was 24 hours after yesterday morning's injection and lower than any FBG for the last few months, except for yesterday. I have no explanation for this. Maybe it's from the smell of the fresh coffee as it wafted its way through the trailer at dawn.

Lunch numbers are coming down also:

1hr after lunch, 129 mg/dL
2hrs after lunch, 110 mg/dL

That's 14% lower than yesterday at 1 hour, and 5% lower at 2 hours. I was going to adjust my injection time one hour later tomorrow morning...but I think I'm going to keep it at 9 AM for a few more days. I'm liking the results. Tomorrow night I'm going to start testing my after dinner numbers as well, see what they look like. If they look good...I think just changing to an AM injection time has answered my question and I'll end the testing.

#15
fgummett

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Ain't that the truth about the back scratcher ;) for an item you can pick up at any dollar store, I can no longer imagine life without one :D Ahhhhh... that's the spot

#16
Granny Shanny

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Ain't that the truth about the back scratcher ;) for an item you can pick up at any dollar store, I can no longer imagine life without one :D Ahhhhh... that's the spot


They're so cheap we keep one in every room! heheh!

#17
soso

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I

FBG this morning was 105. That's amazing considering it was 24 hours after yesterday morning's injection and lower than any FBG for the last few months, except for yesterday. I have no explanation for this.


This is something I wonder about with myself when it happens.. the question I ask.... is my bg a little higher than normal cos I have too much basal and my liver is doing a bang up job of providing the needed glucose? Lack of weight loss belies this theory, but I have to wonder....you know how it is with D.....
SoSo


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#18
NewdestinyX

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And to add.

It's possible to divide your shots up into as many as you like I guess.

As long as they are evenly spaced...

Well.. That's the part that confuses me.. It seems to me that it would be better stated to say -- as long as you don't go over your 'total' dose for the day (rather than they must be evenly spaced). The whole idea of a split injection, from what you guys have shared in the past, is to use Lantus' (or NPH or Levemir's) potency curve (peak) to your advantage to cover certain problem times of the day with greater potency.

If I take 8 of my 16 at 10am and the other 8 in one hour after that -- I still only have 16 in my system for the whole 24 hours.. I just have different potencies -- agreed? Currently I take 13iu of my 16iu at 9:30am and the other 3iu at 11-11:30pm. Because I want the peak to hit 8am or so. If I take the other 3 at 9:30pm, exactly 12 hours after my first than the Lantus 'peak' will hit around 6am which is not when I really need it to hit (Lantus' peak for me is about 4 hours in and then again at 8-10 hours in).
Grant

Dx 7/15/09 - A1c 10.6 :o; 10/26/09-7.2 :); 1/20/10-5.7 :D; 4/10/10-5.6 [Bayer Home Test] :D
Meds: Metformin XR 500mg-2/day, Lantus 16iu morning, Diovan 80mg-1/day,
Nexium 40mg-2/day, D3 2000iu, B12 2500mcg; Diet: for now, low carb:<70g/day
Weight mngm't: Down 30 lbs since Dx :thumbsup: Exercise reg: Biking in combo w/ 45 min at gym 3-4x/week

#19
Bountyman

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FBG numbers this morning...a surprising 104 mg/dL. And that's on the tail end of yesterday's injection. I can live with that.

Instead of my usual breakfast, 2 eggs over easy, 2 strips of bacon, a Gala apple and a cup of coffee I chose to finish off last night's Sloppy Joe's. The same carbohydrates as my lunch test except the lunch test contained 5 grams of sugar, opposed to 13.5 grams of sugar in the Sloppy Joe's. Thought I might as well test this sugary breakfast since I was in a testin' mood.

1hr after breakfast 144 mg/dL
2hrs after breakfast 127 mg/dL

Pretty much what I expected with so much sugar in the Sloppy Joe sauce. Plus the fact I'd eaten this less than a half hour after my morning basal insulin.

Lunch time I ate my usual lunch meal, a hot dog with a couple tablespoons of Raley's Deviled Egg Potato Salad. Have I mentioned how much I like this off-the-shelf potato salad? Well, I do. I've tried everyone's potato salad at one time or another. Wasn't a potato salad fan unless it was on a picnic with cold southern fried chicken and ice-cold beer. Stumbled onto this at the store and I've been hooked on it ever since. Anyway...

1hr after lunch 142 mg/dL
2hrs after lunch 114 mg/dL

Knowing that my meter could be a little off, and that 140 mg/dL an hour after a meal is pushin' it, I think I've found my carbohydrate per meal limit and the best time of the day for my basal insulin. My FBG numbers that range between 100 and 115 I'm not really that concerned about. I've been a high carbohydrate/sugar person all my life. I think my body's used to those numbers and functions fine in that range.

Now, if I were to adopt the attitude that I could just eat to my pleasure, like I used to, yes, I think my body would do just what it did last July...shut down in protest to get my attention. OK, you got my attention.

So, I think we're done here. Any questions? No? Well then, carry on... :D

#20
NewdestinyX

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Now, if I were to adopt the attitude that I could just eat to my pleasure, like I used to, yes, I think my body would do just what it did last July...shut down in protest to get my attention. OK, you got my attention.

So, I think we're done here. Any questions? No? Well then, carry on... :D

Meaning what? That you're happy with the split dose? -- DO tell.. ;)

As for me -- I'm left with a new puzzle.. It seems that this split, 9:30am - 13iu and 9:30pm - 3iu is indeed making better coverage for both my waking number and for the three days I've been on the new regimen my pre-dinner number has been under 100 so it seems the split is meeting my basal needs better -- BUT it working TOO well.. gained 2 lbs in 3 days and hunger came back... UGGGGH!!!!!!! Which means -- since the Lantus is working more efficiently it's pulling even more sugar out of my blood at/near fasting times and therefore taking 16iu in this regimen is still killing my weight loss program. I have one of those 'wrestling "weigh in"' scales - accurate to the 10th of a lb so I know this is an accurate reading. No change in diet in the last 2 days...

All of my FBG's have been a bunch lower these last three day which means 'weight gain' for me..
Yesterday
FBG 89
PreLunch 81
Pre Dinner 90
Today
FBG 81
PreLunch 89
PreDinner 79
----So that means -- I'm backin' down to 14iu tomorrow. I'm good with that!!

This thread has been hugely helpful -- anybody need to push back on my thinking here?
Grant

Dx 7/15/09 - A1c 10.6 :o; 10/26/09-7.2 :); 1/20/10-5.7 :D; 4/10/10-5.6 [Bayer Home Test] :D
Meds: Metformin XR 500mg-2/day, Lantus 16iu morning, Diovan 80mg-1/day,
Nexium 40mg-2/day, D3 2000iu, B12 2500mcg; Diet: for now, low carb:<70g/day
Weight mngm't: Down 30 lbs since Dx :thumbsup: Exercise reg: Biking in combo w/ 45 min at gym 3-4x/week




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